Tuesday, 25 September 2012

Book review: The Medicalization of Society

Title: The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (2007)
Author: Peter Conrad
Publisher: The Johns Hopkins University Press

Continuing the work of pioneers in medicalization such as Irving Zola and Ivan Illich, this veteran but intermittent author on medicalization gives us a sociologist’s perspective on medicalization. Conrad provides us with examples, but also gives us some causes (such as direct-to-consumer advertising, managed care, changing definitions and ‘domain expansion’) and consequences of medicalization.

Conrad illustrates the volume of literature on medicalization by showing the results of an internet search from 2005. I repeated that search in 2012. He found 71,700 hits on Google; I found 541,000. He found 445 articles in Medline I found 689. I guess this means that recognition of the problem is not going away.

Medicalization covers a broad range of conditions, some of which are legitimate conditions for which some people derive benefit from medical treatment, but the diagnostic and treatment thresholds have been altered so that treatment is provided to those who may not benefit, and may be harmed. Take the case of anti-depressants for adolescents for example; it was an extension of their use in adults but there was no benefit, and there was real harm. In other examples, the presence of a disease process is unlikely, such as social anxieties, menopause and short stature. Conrad repeatedly points out that he is not so concerned about the presence of ‘real’ disease; he is more concerned with the social aspects of the “expansion of medical jurisdiction”.

Conrad gives us a fairly comprehensive background to medicalization, including causes, and he rightly points out that it is not just the doctors that are causing the problem. But the background section and the middle section of the book (which provides all the examples) is only of interest to those not familiar with the topic already (and the familiar examples, such as ageing, baldness, erectile dysfunction, menopause and ADHD).

The final section looks again at causes, and adds social consequences. It is a heavy read, and fairly dry, but there is plenty to think about in this section, and abundant references throughout for those wanting more.

I agree with Conrad's fear that “transforming all difference into pathology diminishes our tolerance for and appreciation of the diversity of human life”. And another line I like is:
One can only wonder if hypochondria is still a viable classification, given the huge increase in available medical diagnoses for individual troubles.

I don’t want to be too critical of a senior author that has helped raise the understanding of an important topic, but medicalization does more than lead to overdiagnosis and overtreatment, diminish our tolerance of outliers, and blur the concepts of ‘risk’ and ‘disease’; it harms us. Medicalization does the opposite of what medicine is supposed to do. The social aspects of medicalization are important, but the simple concept of the balance between benefit and harm for many current medical treatments needs to be calculated and reported. This is more likely to correct the current problems than a discussion of the social implications.

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